Current evidence on laparoscopic vs. open resection for gastric stromal tumours

Christos Iordanou; Charalampos A Theodoridis; Panagis M Lykoudis; Dimitrios Dimitroulis; Nikolaos Machairas; Eleftherios Spartalis; Pinelopi Kouki; Emmanouil Pikoulis; Nikolaos Nikiteas

doi:10.3892/ol.2021.12995

Current evidence on laparoscopic vs. open resection for gastric stromal tumours

Oncol Lett. 2021 Oct;22(4):734. doi: 10.3892/ol.2021.12995. Epub 2021 Aug 11.

Authors

Christos Iordanou¹, Charalampos A Theodoridis², Panagis M Lykoudis^{2

3}, Dimitrios Dimitroulis⁴, Nikolaos Machairas⁴, Eleftherios Spartalis⁴, Pinelopi Kouki⁵, Emmanouil Pikoulis², Nikolaos Nikiteas⁴

Affiliations

¹ Department of Hepato-Biliary and Pancreatic Surgery, Metropolitan Hospital, 18547 Piraeus, Greece.
² Third Department of Surgery, 'Attiko' University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
³ Division of Surgery and Interventional Science, University College London, WC1E 6BT London, UK.
⁴ Second Propaedeutic Surgical Department, 'Laiko' Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
⁵ Department of Anaesthetics, General District Hospital of Nikaia 'Agios Panteleimon', 18454 Nikaia, Greece.

Abstract

Although the use of laparoscopic surgery is increasing, controversy still surrounds its application for malignant conditions. Gastrointestinal stromal tumours (GISTs) are less demanding in terms of lymphadenectomy, meaning that laparoscopic resection might have a more defined benefit when compared with open resection. To the best of our knowledge, no randomized study exists that compares the laparoscopic and open resection of GISTs. The current study aimed to examine the relevant literature by means of a systematic review. A systematic literature search was performed individually by two authors, in which three independent databases were searched using specific search-terms. Titles, abstracts and full texts were screened, as well as references to relevant articles, in order to comprise a comprehensive list of studies. Data were extracted using a detailed pre-agreed spreadsheet. Studies were evaluated according to the modified MINORS criteria. A total of 10 studies were included in the present review, yielding a total of 14 entries. The majority of studies reported significantly improved perioperative outcomes for the laparoscopic approach, including improved duration of operation, blood loss and length of hospital stay. Only four studies reported long-term outcomes and findings that were controversial, with some studies detecting no statistically significant differences, one reporting improved and one reporting worse disease-free and overall survival for the laparoscopic group. Three studies were deemed to be good quality, two of which had not reported significantly different long-term outcomes, while the third had reported significantly improved outcomes in the open resection group. While there is a clear benefit for performing laparoscopic surgery in patients with GIST with regards to perioperative outcomes, when it comes to long-term oncological outcomes, uncertainty over its application remains. The lack of randomized trials, as well as the poor reporting of retrospective studies, limits the amount of evidence that is currently available. Laparoscopic surgery for GIST is certainly safe, feasible and likely cost-effective; however, further studies are required to inform on whether this technique is superior to open resection.

Keywords: gastrointestinal stromal tumours; laparoscopic surgery; laparoscopy; minimally invasive surgery; recurrence; survival.

Publication types

Review